| NPI | 1619389616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NJ 22DI02558100) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02558100) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-24 |
| Last Update Date | 2023-10-25 |