| NPI | 1790926244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22d102443200) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY p47148) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2024-04-08 |