| NPI | 1770701500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI00923400) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 027565-1) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI00923400) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 027565-1) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |