| NPI | 1033518428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1856656) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 04054) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |