| NPI | 1033705066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA DDS-09792) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 173) |
| Enumeration Date | 2020-12-14 |
| Last Update Date | 2022-10-24 |