| NPI | 1992729628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: NY 041022) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 041022) |
| 1223X0008X Dentist Oral and Maxillofacial Radiology (Licence: NY 041022) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |