| NPI | 1720232143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857105) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 9813) |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2016-01-07 |