| NPI | 1649284894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN13951) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 034173) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-04-16 |