| NPI | 1437485430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 8097) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 057038) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02404900) | |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2016-02-15 |