NPI | 1881184158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 22DI02767800) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02767800) |
Enumeration Date | 2018-05-12 |
Last Update Date | 2024-06-03 |