NPI | 1285704056 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MD 15215) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 053576) |
122300000X Dentist (Licence: VA 0401413923) | |
Enumeration Date | 2006-11-09 |
Last Update Date | 2015-06-04 |