| NPI | 1497383319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1859344) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: RI DEN03596) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2022-06-20 |