| NPI | 1710211958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA 22312) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 22312) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2017-04-20 |