NPI | 1700218120 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 056843) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02553700) |
Enumeration Date | 2013-08-08 |
Last Update Date | 2021-09-30 |