| NPI | 1316259674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: ME DEN4196) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN4196) |
| 1223P0300X Dentist, Periodontics (Licence: MA DN1857178) | |
| 1223P0300X Dentist, Periodontics (Licence: NH 04512) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2022-02-02 |