| NPI | 1962796615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 054367) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 054367) |
| Enumeration Date | 2011-05-30 |
| Last Update Date | 2015-01-14 |