NPI | 1841669207 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 058267) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 058267) |
Enumeration Date | 2015-09-16 |
Last Update Date | 2020-11-10 |