| NPI | 1982183844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS042874) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858097) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-08-11 |
| Last Update Date | 2020-08-12 |