| NPI | 1083906341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1855848) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: RI DEN03114) |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2016-10-20 |