Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DI21173 | NJ |
NPI | 1114910403 |
---|---|
Provider Name | Dr. Edward Michael Millward |
First Address | Brick, NJ 08723-4022 |
Second Address | Brick, NJ 08723-4022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 20/04/2012 |