| NPI | 1386952687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 056391) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50P69336) |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2019-06-17 |