| NPI | 1851499529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: RI DEN03045) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 041673-1) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1855045) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2009-09-03 |