| NPI | 1326309964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 03976) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN185967) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2021-12-30 |