| NPI | 1851096549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ME DEN5200) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WV 4693) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2025-09-23 |