NPI | 1316935737 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 047414) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 047414) |
Enumeration Date | 2005-10-10 |
Last Update Date | 2023-06-20 |