| NPI | 1720549769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416524) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: VA 0401416524) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-30 |
| Last Update Date | 2022-09-21 |