| NPI | 1235475666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS042981) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 056410) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2024-01-25 |