| NPI | 1437384203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-149C) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 058114) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA DDS109825) | |
| Enumeration Date | 2009-05-22 |
| Last Update Date | 2024-07-25 |