| NPI | 1992957203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS037951) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 050810) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22D102509200) | |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2014-11-18 |