| NPI | 1497387559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 106258) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1859419) |
| 122300000X Dentist (Licence: CT 13445) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 12879) | |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2023-10-25 |