| NPI | 1184156234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN10000688) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10501) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2025-12-12 |