| NPI | 1295718773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 14399) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME 3467) |
| 1223G0001X Dentist, General Practice (Licence: MD 8109) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2013-01-31 |