| NPI | 1871760314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 282208) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054793) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 054793) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2022-07-21 |