| NPI | 1780313700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 064538-01) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02935300) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2026-09-02 |