| NPI | 1326504564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NJ 22D102956200) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223G0001X Dentist General Practice (Licence: NY 061623-01) | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2024-01-29 |