| NPI | 1821398801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI 03253) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 22247) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2026-08-13 |