NPI | 1861646747 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 054360) |
Additional Taxonomies | 122300000X Dentist (Licence: NY P65701) |
Enumeration Date | 2008-11-05 |
Last Update Date | 2016-06-16 |