| NPI | 1255758819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: WI 1001271-15) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30405) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2016-05-31 |