| NPI | 1477035905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN5002) |
| Additional Taxonomies | 122300000X Dentist (Licence: VT 016.0134141) |
| 122300000X Dentist (Licence: CO DEN.00203772) | |
| Enumeration Date | 2018-08-31 |
| Last Update Date | 2023-08-21 |