| NPI | 1992111223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 103594) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057304) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057304) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-07-21 |