| NPI | 1437446994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MA DN1856415) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856415) |
| 122300000X Dentist (Licence: ME DEN4193) | |
| 122300000X Dentist (Licence: NH 04023) | |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2018-10-12 |