| NPI | 1326381716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM TD-00-53) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4062) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2017-03-22 |