| NPI | 1235721523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7209) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 7209) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2026-03-13 |