| NPI | 1487918512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NJ 22DI02594900) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: NJ 22DI02594900) | |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2016-08-28 |