| NPI | 1336480870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 10766525-9923) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039709) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2023-10-25 |