NPI | 1164511325 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 17954) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI01795400) |
1223G0001X Dentist, General Practice (Licence: PA DS027804L) | |
Enumeration Date | 2006-10-12 |
Last Update Date | 2025-06-04 |