| NPI | 1225472053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY NY056497) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056497) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2015-06-25 |