| NPI | 1619383247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1857160) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 11487) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2022-03-11 |