| NPI | 1669909354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011644) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: CA 104883) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2023-08-10 |