| NPI | 1982223574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CT 13953) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA dn1859113) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA DR61069032) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-08-21 |