| NPI | 1770759961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY P58859) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 010004) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2009-03-17 |