| NPI | 1164896395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMAN SOURI President 917-701-3581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: MD 16083) |
| Enumeration Date | 2015-11-27 |
| Last Update Date | 2015-11-27 |