NPI | 1750362232 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 009912) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI01308801) |
Enumeration Date | 2005-11-10 |
Last Update Date | 2019-02-14 |