| NPI | 1326783382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: PA DS044530) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO DEN.00205219) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 122300000X Dentist (Licence: SD D1388) | |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2024-08-29 |