| NPI | 1861675233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 050684) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 252694) |
| Enumeration Date | 2007-12-08 |
| Last Update Date | 2011-10-14 |