| NPI | 1205106606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 1857498) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 2891) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2025-08-08 |