| NPI | 1548878176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401418576) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MA DN1858798) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2024-08-26 |