| NPI | 1427151505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI 03030) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 20707) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2015-02-13 |