| NPI | 1952572869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ME DEN4090) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411893) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2024-05-14 |