| NPI | 1861187205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-10256) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13750) |
| 1223G0001X Dentist, General Practice (Licence: NE 7932) | |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2024-10-16 |