| NPI | 1043899453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN123020) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 17683) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA 17683) | |
| Enumeration Date | 2021-04-04 |
| Last Update Date | 2025-09-30 |