NPI | 1629651484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NY 063510) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS043533) |
Enumeration Date | 2021-04-29 |
Last Update Date | 2024-05-09 |