NPI | 1962619551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NY 048787-1) |
Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 048787) |
Enumeration Date | 2007-05-16 |
Last Update Date | 2022-04-25 |