| NPI | 1699819854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 004605) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 4605) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ DI02564100) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2016-11-28 |