| NPI | 1649956707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 18543) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI03057400) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2025-04-17 |