NPI | 1760856041 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: PA DS040489) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02609900) |
122300000X Dentist (Licence: MA DN1857184) | |
Enumeration Date | 2015-11-24 |
Last Update Date | 2019-01-18 |