NPI | 1528716222 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI02935800) |
Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02935800) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-03-13 |
Last Update Date | 2024-06-23 |