| NPI | 1063606606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ME 3652) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 20170 1) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NH 03555) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2007-08-28 |