| NPI | 1497252233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VI 3087) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416395) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2021-04-06 |