| NPI | 1164540233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02252800) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 054217-1) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2018-03-17 |