| NPI | 1760758262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 056920) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056920) |
| 122300000X Dentist (Licence: CT 11428) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 11428) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2024-01-11 |