| NPI | 1366809949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009706) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401415169) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1001622) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2019-01-09 |