| NPI | 1992893283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 20386) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1000580) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-08-20 |