| NPI | 1447808811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858488) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT DEN-DEN-LIC-31026) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2026-01-14 |