| NPI | 1952621666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NY 282223) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 282223) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2019-11-04 |