| NPI | 1023343019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ME DEN4550) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ME XL3561) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2020-11-02 |