| NPI | 1275556425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 054229-1) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: FL DN17755) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2017-03-09 |