NPI | 1619193521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 046724) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI01985000) |
Enumeration Date | 2007-04-18 |
Last Update Date | 2023-10-10 |