| NPI | 1194042945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2011010371) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN19131) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2025-10-20 |