| NPI | 1487742094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 049440) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 23119) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12011777a) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6853-15) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2014-12-23 |