NPI | 1568454460 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 32813) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI01143300) |
Enumeration Date | 2005-08-17 |
Last Update Date | 2007-07-08 |