NPI | 1710197702 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 31895) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 31895) |
1223G0001X Dentist, General Practice (Licence: NY 031895) | |
Enumeration Date | 2007-05-22 |
Last Update Date | 2007-07-08 |