NPI | 1417191180 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 053253) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 053253) |
Enumeration Date | 2009-04-26 |
Last Update Date | 2009-04-26 |