| NPI | 1114215027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02572500) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 60413) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS039849) | |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2023-06-07 |