| NPI | 1750035713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN10001381) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-5430) |
| Enumeration Date | 2022-02-09 |
| Last Update Date | 2026-07-01 |