NPI | 1306999891 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN0014954) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02039100) |
Enumeration Date | 2007-01-19 |
Last Update Date | 2007-07-08 |