| NPI | 1285224592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NY 062609) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ TBD) |
| 1223G0001X Dentist General Practice (Licence: NJ TBD) | |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2022-08-17 |