| NPI | 1740663202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN10000373) |
| Additional Taxonomies | 104100000X Social Worker |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2024-07-23 |