| NPI | 1619237708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 7117) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: WI 7117) |
| 122300000X Dentist (Licence: ME DEN4255) | |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2013-09-18 |