| NPI | 1477763548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22di02344100) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA ds037015) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2016-02-19 |