| NPI | 1043654098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS039945) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02526900) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 10984) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2020-09-03 |