NPI | 1477115822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02899700) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 13475) |
1223P0221X Dentist, Pediatric Dentistry (Licence: NY 063728) | |
Enumeration Date | 2019-07-06 |
Last Update Date | 2025-05-08 |