NPI | 1922449792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02541100) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056972-1) |
Enumeration Date | 2013-07-09 |
Last Update Date | 2021-08-20 |