NPI | 1629359781 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: TX 28482) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI02481300) |
Enumeration Date | 2011-09-02 |
Last Update Date | 2015-02-17 |