| NPI | 1639274590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02319600) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX L9730) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 23172) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2016-07-09 |