| NPI | 1649567447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02510200) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 056051-1) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2015-08-31 |