| NPI | 1588070635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4429) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN 1856595) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2024-04-29 |