| NPI | 1992202634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL D.0006703-C1) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D.0006703-C1) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL D.0006703-C1) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2024-07-07 |