NPI | 1427207588 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 010018) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 54101) |
Enumeration Date | 2008-09-14 |
Last Update Date | 2013-07-15 |