| NPI | 1598151060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NJ DI027315) |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: NY 060317) | |
| Enumeration Date | 2015-04-12 |
| Last Update Date | 2020-04-03 |