| NPI | 1225047806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: ME DEN4608) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008321) |
| 1223G0001X Dentist, General Practice (Licence: OH 30018265) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2018-02-22 |