| NPI | 1134416316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 28480) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN1855766) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2024-03-06 |