| NPI | 1730408667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412848) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: TN DS0000009596) | |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2017-04-28 |