| NPI | 1871234146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011453) |
| Enumeration Date | 2022-04-02 |
| Last Update Date | 2023-05-16 |