| NPI | 1275188823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4959) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0134075) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2023-08-03 |