| NPI | 1821440264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1857279) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857279) |
| 1223G0001X Dentist, General Practice (Licence: MA DN1857279) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2020-05-07 |