| NPI | 1346777208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1859441) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02864600) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 12534) | |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2024-09-10 |