| NPI | 1932740263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1859522) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859522) |
| 1223G0001X Dentist General Practice (Licence: VT 016.0133920) | |
| 1223G0001X Dentist General Practice (Licence: MI 2901601264) | |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2022-08-22 |