| 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 |