NPI | 1790366177 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN25949) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02862100) |
Enumeration Date | 2021-04-18 |
Last Update Date | 2024-01-07 |