| NPI | 1053672808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02580200) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057282) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2014-08-06 |