| NPI | 1811070121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 11876) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NH 1534) |
| 1223G0001X Dentist, General Practice (Licence: FL 6894) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |