| NPI | 1013064567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME Me3131) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME DEN3131) |
| 1223G0001X Dentist, General Practice (Licence: NH 2027) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2023-08-08 |