| NPI | 1518287507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 16523) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855652) |
| 122300000X Dentist (Licence: NY 056594) | |
| 122300000X Dentist (Licence: MD 16523) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2022-06-24 |