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 |