| NPI | 1780355644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VT 016.0134056) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2023016832) |
| 1223G0001X Dentist, General Practice (Licence: NH 04950) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13751) | |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2024-05-23 |