| NPI | 1285029322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 330252) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 13984) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 063866) | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2024-05-25 |