NPI | 1497887897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02347800) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS036851) |
Enumeration Date | 2007-03-12 |
Last Update Date | 2024-04-30 |