NPI | 1518372051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NY 058022) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02595000) |
Enumeration Date | 2014-06-24 |
Last Update Date | 2016-10-25 |