| NPI | 1912652223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA DN122878) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN122878) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2022-09-09 |