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 |