| NPI | 1518269398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1855594) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 10403) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2010-11-30 |