| NPI | 1770270878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401419053) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7511) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2024-07-16 |