NPI | 1467604363 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 052986-1) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 052986) |
Enumeration Date | 2008-10-22 |
Last Update Date | 2013-12-13 |