| NPI | 1649359746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN18732) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 3123) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2025-07-10 |