| NPI | 1043638158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 061006) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 303939) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02998000) | |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2024-02-19 |