| NPI | 1528016631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 036799) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: NY 001117) |
| 1223G0001X Dentist, General Practice (Licence: NY 036799) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 036799) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-09-20 |