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 |