| NPI | 1255763223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 32381) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN4327) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2023-03-07 |