| NPI | 1346300787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 055352-1) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DRP447) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2013-12-13 |