| NPI | 1851498471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: PR 2708) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 052522) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PR 2708) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 52522) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2024-07-03 |