| NPI | 1821573551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: RI DEN03422) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1858121) |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2020-02-07 |