| NPI | 1578126959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NH 04886) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858963) |
| 122300000X Dentist (Licence: TX 35086) | |
| 1223G0001X Dentist, General Practice (Licence: TX 35086) | |
| Enumeration Date | 2019-04-21 |
| Last Update Date | 2023-09-25 |