| NPI | 1629071154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 056936) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22617) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 056936) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 22617) | |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2021-07-28 |