| NPI | 1891771291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 20619) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401410998) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-07-08 |