| NPI | 1851515514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ME DEN4096) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8397) |
| 1223G0001X Dentist, General Practice (Licence: AK 1199) | |
| 122300000X Dentist (Licence: ME DEN4096) | |
| 1223G0001X Dentist, General Practice (Licence: ME DEN4096) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2011-10-26 |