| NPI | 1336722958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 10657) |
| Enumeration Date | 2021-05-02 |
| Last Update Date | 2026-09-03 |