| NPI | 1477695781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 33220) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 033220) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2024-08-22 |