| NPI | 1942689781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 9359) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1856876) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2018-01-03 |