| NPI | 1194768630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 0360221) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 036022) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2020-10-15 |