| NPI | 1992988893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D012088) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA S-1090) |
| 1223G0001X Dentist, General Practice (Licence: TX 38386) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2024-04-11 |