| NPI | 1487833877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 0536771) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN17782) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MD LL650) | |
| Enumeration Date | 2007-11-01 |
| Last Update Date | 2013-01-08 |