| NPI | 1568954220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D11660) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN4654) |
| 1223E0200X Dentist, Endodontics (Licence: ME DEN4654) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2022-08-22 |