| NPI | 1457615676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02567900) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 058306) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 010888) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2017-12-08 |