| NPI | 1154662815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 057613) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02614300) |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2021-01-21 |