| NPI | 1124076500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22D102457901) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: MD 6833) |
| 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: NJ DI02457900) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS019214L) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-04-01 |