| NPI | 1487207239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 063863) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600226) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2024-06-10 |