| NPI | 1003044850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 055050) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY P70907) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2013-06-24 |