| NPI | 1669558698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 21161) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64302) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2016-04-20 |