| NPI | 1326694845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 24506) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL D.0006679-C1) |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2023-08-08 |