NPI | 1174063002 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 060049) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 060049) |
Enumeration Date | 2017-02-25 |
Last Update Date | 2020-06-23 |