| NPI | 1205351699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: ME DEN4824) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN22869) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2020-08-06 |