| NPI | 1912027293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA 18187) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MA 18187) |
| 1223G0001X Dentist, General Practice (Licence: MA 18187) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2008-06-03 |