| NPI | 1396423828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA DS044208) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS044208) |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2025-07-06 |