| NPI | 1609034685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 60-262981) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 50-055838) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2011-10-31 |