| NPI | 1275099756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IA 40204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30545) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2021-08-16 |