| NPI | 1225229669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 8469) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 05966) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2013-02-25 |