| NPI | 1306108295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME DEN4284) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.023727) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2015-01-07 |