NPI | 1770276503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02997900) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS044082) |
Enumeration Date | 2023-05-29 |
Last Update Date | 2024-09-13 |