| NPI | 1578083564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 06188801) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 06188801) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-04-17 |