| NPI | 1548292725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME DEN4011) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21417) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |