| NPI | 1013321587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10891) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D009008) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2018-10-25 |