| NPI | 1255449765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 050793) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 50793) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2023-07-05 |