| NPI | 1942681069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA DDS102334) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS040383) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02765200) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2021-11-09 |