| NPI | 1295270866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1857484) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857484) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2023-06-20 |