| NPI | 1396437398 |
|---|---|
| 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: NV LL64326) |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2026-08-17 |