| NPI | 1902053804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 051307) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28rj03059000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2010-08-09 |