| NPI | 1063266997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 14251849-9926) |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2026-06-24 |