| NPI | 1528046620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 055288) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 19026285) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2024-04-09 |