| NPI | 1235386400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 12954) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 010518) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2021-03-08 |