| NPI | 1780293381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 04581) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859267) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2022-01-28 |