| NPI | 1982193819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN23916) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 36859) |
| 122300000X Dentist (Licence: NJ 22DI02771800) | |
| 122300000X Dentist (Licence: NY 060443) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2023-05-23 |