| NPI | 1760425904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 051027-01) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 009561) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 07122) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2026-02-04 |