| NPI | 1477886190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI002315100) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 23151) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2016-03-25 |