NPI | 1568650588 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OR D9824) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02178000) |
Enumeration Date | 2007-10-04 |
Last Update Date | 2019-11-05 |