NPI | 1720329162 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: PA DS039093) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02523800) |
Enumeration Date | 2013-03-11 |
Last Update Date | 2013-03-11 |