| NPI | 1629639877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 062073) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1002049) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2021-09-26 |