| 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 |