| NPI | 1124279856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 260012) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 051735) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2024-02-29 |