| 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 |