| NPI | 1053449439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 50 052367) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 58468) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2015-09-04 |