NPI | 1821004573 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 052195-1) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS020298L) |
Enumeration Date | 2006-08-01 |
Last Update Date | 2021-08-13 |