| NPI | 1922369255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: RI DEN03152) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855973) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2014-08-21 |