| NPI | 1821435371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OK 84) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6480) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA S-1001) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2021-10-07 |