| NPI | 1487901740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: MA DN1859750) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: CT 14351) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1859750) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2025-05-10 |