| NPI | 1962757088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CT 12261) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855810) |
| Enumeration Date | 2012-07-15 |
| Last Update Date | 2018-07-17 |