| NPI | 1346251170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 028200-1) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 028200-1) |
| 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: NY 028200-1) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 028200-1) | |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 028200-1) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-12-21 |