NPI | 1619930864 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 047563) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 047563) |
1223G0001X Dentist, General Practice (Licence: NY 047563) | |
Enumeration Date | 2006-04-10 |
Last Update Date | 2020-07-13 |