| NPI | 1093944035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VT 68558) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2009018558) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2010-12-02 |