| NPI | 1639538697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AK 223771) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13106) |
| 122300000X Dentist (Licence: MT 11615) | |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2024-11-27 |