| NPI | 1831400555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1856039) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL10953) |
| 122300000X Dentist (Licence: MA DN1856039) | |
| 1223P0700X Dentist, Prosthodontics (Licence: MA DN1956039) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2020-10-21 |