| NPI | 1285637199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 044810) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ DI 18951) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2022-04-06 |