NPI | 1558859488 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI03076500) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI03076500) |
Enumeration Date | 2018-04-26 |
Last Update Date | 2025-05-06 |