| NPI | 1811440258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 108713) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857557) |
| 122300000X Dentist (Licence: CT 012252) | |
| 122300000X Dentist (Licence: NY 062458) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2024-05-15 |