| NPI | 1447907464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901601343) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901601343) |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2024-06-05 |