| NPI | 1538526041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02634700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 058678) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2018-06-21 |