| NPI | 1205150190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 6484C) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02509400) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: AR 4193) | |
| 208200000X Plastic Surgery (Licence: AR E-10461) | |
| Enumeration Date | 2010-03-21 |
| Last Update Date | 2018-07-30 |