| NPI | 1114510716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02852300) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN26058) |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2024-09-25 |