NPI | 1558047852 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI03017800) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 18069) |
Enumeration Date | 2023-06-22 |
Last Update Date | 2024-04-28 |