| NPI | 1255987780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: ME DEN4942) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL D0006681-C1) |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2023-04-24 |