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 |