| NPI | 1518307743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 306840) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 057483) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 057483) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2022-08-14 |