| NPI | 1649310988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI DEN-02635) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 19429) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-09 |