NPI | 1154551372 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 010074) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 055401) |
Enumeration Date | 2009-07-22 |
Last Update Date | 2019-08-12 |