| NPI | 1295013662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1855853) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ME DEN4207) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2018-12-22 |