| NPI | 1750120515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 064711) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2025-08-26 |