| NPI | 1447523667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA OMS125) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 059801) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 294967) | |
| Enumeration Date | 2012-02-18 |
| Last Update Date | 2024-03-25 |