| NPI | 1518608751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: WA 1111111) |
| Enumeration Date | 2022-04-03 |
| Last Update Date | 2022-04-03 |