| NPI | 1417152810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 50 - 055978) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1855922) |
| 1223D0001X Dentist, Dental Public Health (Licence: NY 50 - 055978) | |
| 1223D0001X Dentist, Dental Public Health (Licence: MA DN1855922) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2013-02-27 |