NPI | 1871666339 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 044627) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 0446271) |
1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS030426L) | |
Enumeration Date | 2006-11-15 |
Last Update Date | 2016-02-03 |