| NPI | 1194969378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 103573) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 055232) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WI 1001955) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY P65488) | |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2021-05-25 |