| NPI | 1033690052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 36400) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL13750) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2022-08-30 |