| NPI | 1427220029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 25MA09486700) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: GA DN013572) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA 68711) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22DI02563600) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 274404) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 057128) | |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2014-06-20 |