NPI | 1588706758 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 040958) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02780111) |
Enumeration Date | 2007-02-13 |
Last Update Date | 2023-01-04 |