| NPI | 1114594991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1859099) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: FL DN26238) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2021-07-20 |