| NPI | 1952562852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 57460) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 50-053063-1) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2011-01-27 |