| NPI | 1518608918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 063929) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 18381) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2025-07-15 |