| NPI | 1730682246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02973900) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042351) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-10 |
| Last Update Date | 2023-11-21 |