| NPI | 1356481857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 21160) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 3454) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2009-04-24 |