| NPI | 1730637414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DL13077) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA DL13077) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2017-06-06 |