NPI | 1144585605 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NY 059481) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 62737) |
Enumeration Date | 2012-07-11 |
Last Update Date | 2022-07-13 |