NPI | 1720118375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 000248) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 32715) |
1223G0001X Dentist, General Practice (Licence: CO 7717) | |
Enumeration Date | 2007-03-06 |
Last Update Date | 2014-05-15 |