| NPI | 1649813247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13407) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02786500) |
| Enumeration Date | 2019-10-26 |
| Last Update Date | 2026-01-27 |