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 |