| NPI | 1487328563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1859237) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 04675) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2024-05-15 |