NPI | 1255485165 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 045056) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 045056) |
Enumeration Date | 2007-01-22 |
Last Update Date | 2019-02-12 |