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 |