| NPI | 1659682672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22D102499600) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DR02309) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2012-07-02 |