NPI | 1174939557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 50 057503) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11202) |
Enumeration Date | 2014-07-07 |
Last Update Date | 2015-10-19 |