| NPI | 1033347588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 03802) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855179) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2021-03-17 |