NPI | 1558058362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI03003700) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 064153) |
Enumeration Date | 2023-04-20 |
Last Update Date | 2025-06-03 |