| NPI | 1528716222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 332270) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 064573) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI02935800) | |
| Enumeration Date | 2022-03-13 |
| Last Update Date | 2026-06-17 |