| NPI | 1891995692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 009872) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 053574) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2012-03-19 |