| NPI | 1023492881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401418371) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 31307) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-11 |
| Last Update Date | 2023-12-27 |