| NPI | 1003945528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4794) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 4465-15) |
| 122300000X Dentist (Licence: ME D4794) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2022-06-15 |