| NPI | 1225605108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2024008063) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2024008063) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2026-06-09 |