| NPI | 1285859686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 03808) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VT 953) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2016-06-20 |