Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DL11728 | MA |
NPI | 1295085249 |
---|---|
Provider Name | Omair Bukhari |
First Address | Malden, MA 02148-4832 |
Second Address | Boston, MA 02115-5819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2012 |
Last Update Date | 18/09/2012 |