| NPI | 1144279191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 044038) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 208101) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2010-11-17 |