NPI | 1760566921 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NY 042987) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 064061) |
1223P0300X Dentist, Periodontics (Licence: NY 042987) | |
Enumeration Date | 2006-10-24 |
Last Update Date | 2025-02-21 |