NPI | 1730362252 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ DI23604) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NJ 22DI02360400) |
Enumeration Date | 2007-12-06 |
Last Update Date | 2012-07-03 |