NPI | 1588243539 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02991000) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS044274) |
Enumeration Date | 2021-04-06 |
Last Update Date | 2023-08-07 |