NPI | 1508511726 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NY 064284-01) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13413) |
Enumeration Date | 2022-02-16 |
Last Update Date | 2024-10-20 |