NPI | 1982756391 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 039529) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN13283) |
1223G0001X Dentist, General Practice (Licence: OR D11183) | |
Enumeration Date | 2007-01-17 |
Last Update Date | 2020-02-06 |