| NPI | 1174147375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 062143) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02828400) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2022-03-07 |