| NPI | 1225432677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1857914) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: RI DEN03390) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2019-12-28 |