| NPI | 1427416353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ 9939) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P97309) |
| Enumeration Date | 2016-02-06 |
| Last Update Date | 2018-05-16 |