| NPI | 1912248683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI02564200) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 300173) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 060757) | |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2019-10-11 |