| NPI | 1487039186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1857327) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 6211) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2024-08-02 |