| NPI | 1679702997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NJ 22DI02433500) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 50 054251) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2016-11-28 |