| NPI | 1184186066 |
|---|---|
| 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 22Di02795400) |
| 122300000X Dentist (Licence: NY 061250) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2022-06-10 |