| NPI | 1467182246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA DDS-09996) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IA DDS-09996) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2022-07-29 |