NPI | 1649284894 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN13951) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 034173) |
Enumeration Date | 2006-07-27 |
Last Update Date | 2023-04-16 |