| NPI | 1538242417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 030332) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 030332) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2018-01-17 |