| NPI | 1639527690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI DEN03452) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11814) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2019-11-24 |