| NPI | 1891319638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 17898) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02919900) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IA DDS-10077) | |
| Enumeration Date | 2020-06-07 |
| Last Update Date | 2025-10-20 |