| NPI | 1760505440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CO 8332) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053438) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2012-05-10 |