| NPI | 1407312937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MD 17392) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401417932) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2025-10-31 |