| NPI | 1336196823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MA 20102) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NH 03672) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: NY 053493-1) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2009-09-09 |