| NPI | 1710022942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013851) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02198100) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 050223) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2010-09-22 |