| NPI | 1124317979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 055279) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 010478) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2016-10-20 |