NPI | 1215501044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 062572) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2021-05-17 |
Last Update Date | 2022-12-08 |