| NPI | 1710274246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NY 0562981) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223P0221X Dentist Pediatric Dentistry (Licence: NJ 22DI02493900) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2012-09-24 |