| NPI | 1104389279 |
|---|---|
| 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 22DI02804500) |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2026-08-11 |