| NPI | 1285947564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1855410) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 03790) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2015-01-12 |