| NPI | 1720463326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 011501) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2015-11-15 |