| NPI | 1184851354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA dn1855260) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI den03099) |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2011-09-28 |