| NPI | 1831438787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D009393) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D009393) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02574900) | |
| 1223G0001X Dentist, General Practice (Licence: NY 057466-1) | |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2024-03-11 |