| NPI | 1790168177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 059276) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DL-12553) |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2024-02-08 |