| NPI | 1730871625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN28968) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D011903) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-07-10 |