| NPI | 1306969415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 053589) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 247005) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2013-06-21 |