| NPI | 1699397984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KY 10989) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH 30.027110) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2023-06-27 |