| NPI | 1437530771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: DC DEN2000044) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MD 17427) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 122300000X Dentist (Licence: VA 0401414887) | |
| 1223E0200X Dentist, Endodontics (Licence: VA 0401414887) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2021-11-20 |