| NPI | 1750655627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D9064) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ D009064) |
| 1223G0001X Dentist, General Practice (Licence: UT 8350105-9921) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2022-07-21 |