NPI | 1912621210 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 062781) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 062781) |
Enumeration Date | 2022-09-29 |
Last Update Date | 2023-04-03 |