| NPI | 1891920575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 058413) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY P69669 LimitedPermit) |
| Enumeration Date | 2009-05-25 |
| Last Update Date | 2020-10-12 |