| NPI | 1407203417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 063873) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13718) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 68357) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 29839) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OK 232) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2024-06-07 |