| NPI | 1336220466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI0198470) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ di19847) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI0198470) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2016-11-18 |