| NPI | 1871190926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME DEN-5004) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT-2866) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2023-01-31 |