| NPI | 1235709726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859539) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME DEN4883) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2023-05-18 |