NPI | 1982605952 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ DI019452) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: NY 043124) |
Enumeration Date | 2005-08-02 |
Last Update Date | 2021-03-31 |