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 |