| NPI | 1396397634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MD 17967) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02761700) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2023-06-05 |