| NPI | 1316353204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 058536) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD LL756) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2025-03-11 |