| NPI | 1487717187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D7529) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 051761) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2008-10-22 |