| NPI | 1487989711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1859287) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 010142) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2023-07-31 |