| NPI | 1174217129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: VA 0401418548) |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2025-08-06 |