| NPI | 1801136106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 060616) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.028278) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS045517) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 4835) | |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2026-03-11 |