| NPI | 1386138170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NH 05134) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859075) |
| 1223G0001X Dentist, General Practice (Licence: TX 34251) | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2024-09-12 |