| NPI | 1649628348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI DEN03585) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859206) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2021-12-02 |