| NPI | 1649214651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 035611) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 035611) |
| 174400000X Specialist (Licence: NY 035611) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2019-07-19 |