| NPI | 1164471363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN21274) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30-022310) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 10818) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2013-05-31 |