NPI | 1326206970 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN 20012) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02406400) |
1223G0001X Dentist, General Practice (Licence: PA DS031451L) | |
Enumeration Date | 2008-05-30 |
Last Update Date | 2014-04-28 |