| NPI | 1700529740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02936302) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN27425) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02936301) | |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02936300) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2023-08-02 |