| NPI | 1912402868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4632) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35763) |
| 1223G0001X Dentist, General Practice (Licence: NV LL463-18) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2022-11-16 |