| NPI | 1972925287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 065150) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 29442) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2025-10-03 |