NPI | 1285637199 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 044810) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ DI 18951) |
Enumeration Date | 2005-05-24 |
Last Update Date | 2022-04-06 |