NPI | 1891367967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02879200) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 26147) |
Enumeration Date | 2021-07-16 |
Last Update Date | 2024-01-10 |