NPI | 1780886473 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 052597-1) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02221900) |
Enumeration Date | 2007-06-04 |
Last Update Date | 2009-12-20 |