| NPI | 1346245990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME DEN4733) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 5197) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2019-08-27 |