NPI | 1780675298 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: PA DS029756L) |
Additional Taxonomies | 122300000X Dentist (Licence: IA DDS-09035) |
122300000X Dentist (Licence: NJ 22D102312900) | |
Enumeration Date | 2005-11-03 |
Last Update Date | 2013-08-07 |