NPI | 1083688147 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410785) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13147) |
1223G0001X Dentist, General Practice (Licence: NY 049343-1) | |
Enumeration Date | 2006-02-15 |
Last Update Date | 2007-07-08 |