| NPI | 1437636677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: IA 40205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 30537) |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2021-08-20 |