| NPI | 1336702521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI0-2781600) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 062205-01) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-02-28 |