| NPI | 1558622019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 9965) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401413662) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2022-08-12 |