| NPI | 1154521201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI DEN03011) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 053566) |
| 122300000X Dentist (Licence: MA 22217) | |
| 1223G0001X Dentist, General Practice (Licence: CT 009884) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2015-04-08 |