| NPI | 1760510044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI den02619) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 19214) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-07-08 |