| NPI | 1669893178 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1856351) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856351) |
| Enumeration Date | 2013-12-31 |
| Last Update Date | 2016-02-08 |