| NPI | 1023638491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02801400) |
| 122300000X Dentist (Licence: MA DN1859008) | |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02801400) | |
| 1223G0001X Dentist, General Practice (Licence: MA DN1859008) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-25 |
| Last Update Date | 2023-04-19 |