| NPI | 1881186559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DF11701) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060542) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2021-05-20 |