NPI | 1578896676 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 054465-1) |
Additional Taxonomies | 122300000X Dentist (Licence: CT 010096) |
Enumeration Date | 2009-09-09 |
Last Update Date | 2015-05-07 |