| NPI | 1265131403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4898) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 41664) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2026-01-19 |