| NPI | 1134341068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401413546) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 52774) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 052774) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2015-01-12 |