| NPI | 1427449990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 062002) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02760700) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI02760700) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 062002) | |
| 208600000X Surgery (Licence: NY 307581) | |
| 208600000X Surgery (Licence: NJ 25MA11723200) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2023-03-22 |