| NPI | 1700406683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 061937) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019.032975) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2024-02-27 |