| NPI | 1518207430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NH 04561) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 060412) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA DN1858663) | |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2020-11-23 |