| NPI | 1851540413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 054113) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054113) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2023-02-01 |