| NPI | 1437610078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PR 3430) |
| Additional Taxonomies | 122300000X Dentist (Licence: PR 3430) |
| 1223G0001X Dentist, General Practice (Licence: LA 7048) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2023-09-21 |