| NPI | 1952895815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VT 016.0133932) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1858008) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2020-07-21 |