| NPI | 1598285454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D13918) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME DEN4572) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2019-10-31 |