| NPI | 1225161011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 02456) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN16217) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2017-11-16 |