| NPI | 1285258715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10976) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: ME DEN4796) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2025-03-06 |