| NPI | 1740438464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ME DEN4299) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037336) |
| Enumeration Date | 2008-09-06 |
| Last Update Date | 2014-03-20 |