NPI | 1720200421 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ DI018407) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: PA DS028324L) |
Enumeration Date | 2007-05-03 |
Last Update Date | 2022-04-27 |