| NPI | 1386937209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 057787) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401410440) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000163) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2015-05-04 |