NPI | 1740355247 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 024172) |
Additional Taxonomies | 261Q00000X Clinic/Center (Licence: NY 024172) |
Enumeration Date | 2006-11-21 |
Last Update Date | 2007-07-09 |