NPI | 1780654947 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NJ 14655) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 38634) |
122300000X Dentist (Licence: FL 10236) | |
Enumeration Date | 2006-01-23 |
Last Update Date | 2007-07-09 |