| NPI | 1750347498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: LA 5776) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22D102219000) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 050487) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 227864) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-24 |