NPI | 1750814059 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 060751) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 103166) |
Enumeration Date | 2017-04-04 |
Last Update Date | 2024-07-11 |