| NPI | 1235587908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN015381) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN015381) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA DN015381) | |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2020-07-01 |