| NPI | 1184893737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DL100726) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 05241) |
| 122300000X Dentist (Licence: FL 30125) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2025-08-05 |