| NPI | 1366823320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 04332) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1856915) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-04-30 |