| NPI | 1851617229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6664-15) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: WI 6664-15) |
| 1223G0001X Dentist, General Practice (Licence: WI 6664-15) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-10 |
| Last Update Date | 2025-02-26 |