| NPI | 1326428863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1857649) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 11863) |
| Enumeration Date | 2015-05-30 |
| Last Update Date | 2022-07-21 |