NPI | 1265446819 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011086) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 040252-1) |
Enumeration Date | 2006-07-28 |
Last Update Date | 2023-12-13 |