| NPI | 1194040782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 291460) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 14666) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 058649) | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2018-02-17 |