| NPI | 1770830622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1856715) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 03927) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2018-09-27 |