| NPI | 1245691351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 061555) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34507) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2024-10-14 |