NPI | 1669996930 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 062381) |
Additional Taxonomies | 122300000X Dentist (Licence: MN D13903) |
1223G0001X Dentist, General Practice (Licence: MN D13903) | |
1223G0001X Dentist, General Practice (Licence: TX 36835) | |
Enumeration Date | 2017-07-28 |
Last Update Date | 2023-03-31 |