| NPI | 1255198081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NV 8039) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 122300000X Dentist (Licence: OH 30.027470) | |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2024-07-17 |