| NPI | 1093976292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 053803) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053803) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02252000) | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2015-10-13 |