| NPI | 1477982635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1857684) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59606) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2021-02-10 |