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 |