NPI | 1386710812 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MA 19917) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 046211) |
122300000X Dentist (Licence: HI 2222) | |
Enumeration Date | 2006-11-27 |
Last Update Date | 2007-07-08 |