| NPI | 1710431093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 062847) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10519) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2022-11-01 |