| NPI | 1336281856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AZ 6420) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: NY 042144) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 042144) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-06-18 |