| NPI | 1538581301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057061-1) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CO 00202757) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00202757) | |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2017-03-01 |