| NPI | 1386901262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02600000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15370) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1001129) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2015-07-12 |