NPI | 1558748426 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 060254) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS040565) |
Enumeration Date | 2015-04-30 |
Last Update Date | 2022-09-07 |