| NPI | 1245458553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: ME DEN5031) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MO 014712) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2023-06-07 |