| NPI | 1720561459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 13798) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MA 13798) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2019-04-17 |