NPI | 1851690184 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 056328) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02464400) |
Enumeration Date | 2011-03-25 |
Last Update Date | 2018-04-13 |