| NPI | 1295076206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NJ 22DI02607800) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040101) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2021-07-22 |