| NPI | 1831547678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 1859249) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64919) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2023-11-13 |