| NPI | 1689288755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 10116) |
| Additional Taxonomies | 171W00000X Contractor |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2022-04-07 |