| NPI | 1477724706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN16554) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 52780) |
| Enumeration Date | 2008-03-14 |
| Last Update Date | 2022-08-09 |