| NPI | 1598853632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 043998-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 043998) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-03-30 |