| NPI | 1750499117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 051767) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN FF50) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2012-07-17 |