| NPI | 1720645047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1858293) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 04488) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2019-06-17 |