| NPI | 1659517498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1855058) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 57983) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2013-02-19 |