| NPI | 1700293586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NH 04424) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040708) |
| 122300000X Dentist (Licence: VT 016.0105031) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2022-10-27 |