NPI | 1669204665 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NY 064134) |
Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: NY 027079) |
1223P0300X Dentist, Periodontics (Licence: NJ 22DI03015600) | |
Enumeration Date | 2024-08-17 |
Last Update Date | 2024-08-19 |