| NPI | 1003161191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 060287) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021171) |
| 122300000X Dentist (Licence: IL 019029781) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS040221) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 021002603) | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2019-08-20 |