| NPI | 1508486614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02836300) |
| 1223G0001X Dentist, General Practice (Licence: FL DN25740) | |
| 1223G0001X Dentist, General Practice (Licence: NY 062239-01) | |
| Enumeration Date | 2020-04-18 |
| Last Update Date | 2022-12-13 |