NPI | 1598853632 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 043998-1) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 043998) |
Enumeration Date | 2006-10-11 |
Last Update Date | 2021-03-30 |