| NPI | 1770825887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: GA DN014644) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2020-07-01 |