| NPI | 1215670922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS045101) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL15907) |
| 122300000X Dentist (Licence: MA DN10000146) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2025-06-30 |