| NPI | 1811488398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: SC DGD.10308) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 060515) |
| 1223G0001X Dentist General Practice (Licence: SC 10108) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2022-08-11 |