| NPI | 1548990476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 064060) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02998400) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 27287) | |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2024-08-11 |