| NPI | 1407647829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 2.014402) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN10000929) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-05-15 |
| Last Update Date | 2025-07-01 |