| NPI | 1922598093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 2.012180-RES) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 2.012180-RES) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2018-06-04 |