| NPI | 1619381878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NJ 22DI02562900) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ 22DI02562900) |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2023-07-03 |