| NPI | 1821295452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MA DN1855617) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 053504) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2013-01-23 |