NPI | 1144462649 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 051994) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: DE G1-0001269) |
Enumeration Date | 2009-03-30 |
Last Update Date | 2018-10-18 |