| NPI | 1194834135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 8275) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 21397) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02305600) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |