| NPI | 1013418185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL 166526) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 02734000) |
| 122300000X Dentist (Licence: CT 12639) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 29367) | |
| 208600000X Surgery (Licence: NY 318937) | |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2024-07-17 |