| NPI | 1760529499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME TLD5285) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 00206399) |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00206399) | |
| 122300000X Dentist (Licence: ME TLD5285) | |
| 1223G0001X Dentist, General Practice (Licence: NY 048827) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2025-10-02 |