| NPI | 1922062728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 2183387) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 046690) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 046690) | |
| 174400000X Specialist (Licence: NY 218337) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2007-07-30 |