| NPI | 1780255794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859407) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS106411) |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2022-08-16 |