NPI | 1639303357 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 054323-1) |
Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 054323) |
Enumeration Date | 2009-05-09 |
Last Update Date | 2023-11-09 |