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 |