| NPI | 1841919289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL D.007257-C1) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 6001093) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2023-10-18 |