| NPI | 1396044640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 281551) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 059306) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI02606800) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 25MA10164600) | |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2018-03-17 |