NPI | 1235541038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 060306-1) |
Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 001297) |
Enumeration Date | 2014-05-28 |
Last Update Date | 2020-01-28 |