| NPI | 1942555859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1857550) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857550) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2023-07-24 |