NPI | 1194091538 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 22506) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 056969) |
Enumeration Date | 2012-03-29 |
Last Update Date | 2022-07-21 |