| 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 |