| NPI | 1528635638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1858998) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: SC DGD10295) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2022-07-18 |