| NPI | 1396905188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 057328) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 11099) |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2026-02-05 |