NPI | 1992007512 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 61370) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 055240) |
Enumeration Date | 2010-12-02 |
Last Update Date | 2023-02-15 |