| NPI | 1891426235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ FA1804637) |
| 122300000X Dentist (Licence: AZ D011510) | |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2022-07-26 |