NPI | 1104942606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NY 047291) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11091) |
Enumeration Date | 2007-03-22 |
Last Update Date | 2019-06-05 |