| NPI | 1013200641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1856102) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NH 04003) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2015-09-11 |