| NPI | 1649590852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NH NH03890) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855419) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2023-02-02 |