| NPI | 1932488152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1857135) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 059493) |
| 208600000X Surgery (Licence: NY 291410) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2020-06-16 |