| NPI | 1730606781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 060559) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA DDS107353) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02999800) | |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2023-10-16 |