NPI | 1124154158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 052129) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 052129) |
Enumeration Date | 2007-02-26 |
Last Update Date | 2012-10-03 |