| NPI | 1013619188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 11034) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN5061) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2025-06-18 |