| 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 |