NPI | 1457668279 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 043896) |
Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: NY 043896) |
Enumeration Date | 2010-09-01 |
Last Update Date | 2010-09-01 |