| NPI | 1578792230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 055069) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 54725) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ DI02526600) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2014-07-21 |