| NPI | 1912622572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1859731) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 27533) |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2023-09-28 |