| NPI | 1912307273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1856718) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856718) |
| 1223P0700X Dentist, Prosthodontics (Licence: MA DN1856718) | |
| Enumeration Date | 2014-08-23 |
| Last Update Date | 2023-06-13 |