| NPI | 1164008686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ D011711) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MA DN1859285) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2023-10-13 |