| NPI | 1942793104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 100226515) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: IA DDS-09873) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30529) | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2021-08-25 |