| NPI | 1013991959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1855261) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: TN 8424) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2022-01-06 |