| NPI | 1205335627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NJ 22DI02816500) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 061076) |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2022-04-27 |