| NPI | 1174229991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 14443) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03069600) |
| 122300000X Dentist (Licence: CT 2.014443) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 064987) | |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2025-08-06 |