| NPI | 1598095267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 056648) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 271535) |
| 208600000X Surgery (Licence: NY 271535) | |
| Enumeration Date | 2010-01-01 |
| Last Update Date | 2022-02-23 |