| NPI | 1780022822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 9752) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2014-06-05 |