NPI | 1306849898 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI022697) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 050821-1) |
Enumeration Date | 2005-05-27 |
Last Update Date | 2007-10-26 |