| NPI | 1689028581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PR 3240) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 059438) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-17 |
| Last Update Date | 2023-03-30 |