NPI | 1558552901 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 59275) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DIO2432700) |
Enumeration Date | 2007-08-08 |
Last Update Date | 2020-01-28 |