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 |