| NPI | 1336790609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 04721) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858485) |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2024-09-09 |