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 |