| NPI | 1477624989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 048825-1) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 20681) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 251014) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2008-12-23 |