| NPI | 1962818633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D009608) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ 9608) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30407) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2022-09-27 |