| NPI | 1356503890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 60946) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02370100) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2012-12-03 |