NPI | 1053638387 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 280315) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 058602) |
Enumeration Date | 2010-04-26 |
Last Update Date | 2016-07-27 |