| NPI | 1619232899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1855992) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 03917) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2014-01-25 |