| NPI | 1699453118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI03004300) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 064811-01) |
| 122300000X Dentist (Licence: NY 064811-01) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CT 14491) | |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2026-06-18 |