| NPI | 1821385006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 056311) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 056311) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2018-07-19 |