| NPI | 1235783622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 10001-23) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7272) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2024-01-15 |