| NPI | 1619435740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: AZ D011298) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: UT 12840183-9921) | |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2024-01-05 |