NPI | 1730555947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1859783) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2015-08-11 |
Last Update Date | 2023-07-11 |