| NPI | 1841873478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4912) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 13945) |
| Enumeration Date | 2021-05-02 |
| Last Update Date | 2024-04-11 |