| NPI | 1518510700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI DEN03490) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858587) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2023-07-03 |