| NPI | 1871935742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 9518) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057628) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2021-01-25 |