| NPI | 1932418886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: RI DEN03093) |
| Additional Taxonomies | 122300000X Dentist (Licence: RI DEN03093) |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2016-07-13 |