| NPI | 1851915060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN4789) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ME 4789) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2022-11-21 |