| NPI | 1245973874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS044554) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI03021200) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2022018786) | |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2025-07-18 |