| NPI | 1336160472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN20864) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA 20864) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2023-11-20 |