| NPI | 1962854497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN10001427) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34597) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.24855) | |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2026-07-28 |