NPI | 1801049234 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DIO1785000) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NJ NJ-3807) |
Enumeration Date | 2008-10-29 |
Last Update Date | 2008-10-29 |