| NPI | 1609822634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN3093) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME 3093) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2023-06-06 |