NPI | 1275675795 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 051447) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 051447) |
Enumeration Date | 2007-02-12 |
Last Update Date | 2024-02-01 |