| NPI | 1891565354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 13899501-9926) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: WA DENT.DE.61516235) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-01-05 |
| Last Update Date | 2026-04-09 |