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 |