| NPI | 1659555001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN17160) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY P44962) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2017-03-01 |