| NPI | 1780602920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 049087-1) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 240428-1) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2009-07-20 |