| NPI | 1669684114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 055456-1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02268000) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2013-12-19 |