| NPI | 1316630460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA RES-30649) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IA RES-30649) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2026-07-08 |