| NPI | 1871888735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 9474332-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056200) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2015-08-25 |