| NPI | 1033340005 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1857046) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH232676) |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2016-09-14 |