| NPI | 1265578488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI01992900) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 19929) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2018-05-07 |