NPI | 1457569543 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 048797) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ DI02125300) |
Enumeration Date | 2007-05-20 |
Last Update Date | 2007-07-08 |