| NPI | 1790679157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS045002) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 065381) |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2026-04-21 |