| NPI | 1912496613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 063172) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 063172) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2023-08-01 |