| NPI | 1154736130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1856610) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11245) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2019-11-14 |