| NPI | 1417513730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA D015858) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA DN015858) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2020-08-30 |