| NPI | 1154450187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 11753) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: RI DEN01637) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2009-01-06 |