| NPI | 1003268285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA Dn015613) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA DN015163) |
| 122300000X Dentist (Licence: GA dn015163) | |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2021-11-20 |