| NPI | 1508320532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1858555) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00203866) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2024-03-25 |