| NPI | 1144537440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN03590) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038494) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2021-11-30 |