| NPI | 1134123490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 11226) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 32582) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2007-07-08 |