| NPI | 1558744912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN122827) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600896) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2022-08-02 |