| NPI | 1952405235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 047130-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 047130-1) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2024-11-11 |