NPI | 1245458876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 051576) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02314000) |
Enumeration Date | 2007-04-20 |
Last Update Date | 2007-07-08 |