| NPI | 1932760790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN185863) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 1858365) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2023-05-01 |