| NPI | 1366601478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22dI01390100) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI01390100) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2008-06-03 |