| NPI | 1912648601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 13535) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 064499) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-03-25 |