| NPI | 1902430903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 065311) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI03132800) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2024047430) | |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2026-07-20 |