| NPI | 1710945654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS037465) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 5256838) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2014-08-21 |