| NPI | 1093482291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 30.026634) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.026634) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2022-12-28 |