| NPI | 1366942179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA D18199) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2021040142) |
| Enumeration Date | 2018-02-19 |
| Last Update Date | 2024-11-05 |