NPI | 1730108580 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 038838) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22D101545700) |
1223G0001X Dentist, General Practice (Licence: CA 32946) | |
Enumeration Date | 2006-07-19 |
Last Update Date | 2007-07-08 |