| NPI | 1992452288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI02960400) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 063303-01) |
| 122300000X Dentist (Licence: NJ 22DI02960401) | |
| 122300000X Dentist (Licence: NJ 22DI02960402) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-07 |
| Last Update Date | 2023-12-03 |