| NPI | 1659704799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 10136) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL11938) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2023-11-29 |