| NPI | 1215044458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN03178) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: RI DEN03178) |
| 1223G0001X Dentist, General Practice (Licence: CT 12544) | |
| 1223G0001X Dentist, General Practice (Licence: MA 21146) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2023-10-02 |