| NPI | 1760969216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 125Q00000X Oral Medicinist (Licence: MA DF11947) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DF11864) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2023-10-26 |