| NPI | 1154858033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 063143) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 311698) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2023-12-06 |