| NPI | 1982260360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5145) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 35436) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2020-06-15 |