| NPI | 1922747849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI03021100) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00205825) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2025-02-16 |