| NPI | 1427223486 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010505) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02965600) |
| 1223G0001X Dentist, General Practice (Licence: MA DN21575) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2023-06-08 |