| NPI | 1376115519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 13246) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044638) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 1376115519) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2024-06-10 |