NPI | 1083884423 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 054012-1) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02370200) |
Enumeration Date | 2008-02-29 |
Last Update Date | 2016-01-20 |