| NPI | 1770040735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D.0006775-C1) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24882) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2020-06-16 |