NPI | 1649610536 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CA DDS63130) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02540600) |
Enumeration Date | 2013-06-25 |
Last Update Date | 2016-09-16 |