| NPI | 1568423481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MA 17094) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NH 3217) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2007-07-08 |