| NPI | 1942211180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 18568) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 053006) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2014-11-24 |