NPI | 1437122025 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 12118) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: FL DN20964) |
Enumeration Date | 2006-02-13 |
Last Update Date | 2021-06-30 |