| NPI | 1194858647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 21705) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN29743) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2025-01-31 |