| NPI | 1275550220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA 16805) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 23130-875) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2022-09-21 |