| NPI | 1811459662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4818) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2019019264) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2025-12-17 |