| NPI | 1275054785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 329411) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 329411) |
| 207Y00000X Otolaryngology (Licence: NY 329411) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: NY 329411) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2024-11-25 |