| NPI | 1306133392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 11888) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057168) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2020-08-10 |