| NPI | 1851403083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA 14984) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MA 216236) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-07-08 |