| NPI | 1346989555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7549) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL D-0007089-C1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2024-07-09 |