| NPI | 1124289905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 053210) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DE C1-0011804) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DE G3-0000458) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 269333) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2018-12-10 |