| NPI | 1578902672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1856866) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME 4324) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2018-09-04 |