| NPI | 1326293614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 053029) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22DI02506200) |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2020-12-30 |