NPI | 1538779319 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NY 062790) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02805600) |
Enumeration Date | 2020-08-05 |
Last Update Date | 2024-02-14 |