| NPI | 1154586006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME 4077) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 9952) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2013-06-27 |