NPI | 1043691157 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 058508-1) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 058508-1) |
Enumeration Date | 2015-06-15 |
Last Update Date | 2022-07-21 |