| NPI | 1154595734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 052151) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 260072) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2013-07-15 |