| NPI | 1427481266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1856380) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: RI Den03198) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2024-08-17 |