NPI | 1770599169 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NY 050238) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ DI 20881) |
122300000X Dentist (Licence: MD 12594) | |
Enumeration Date | 2006-07-31 |
Last Update Date | 2007-07-09 |