| NPI | 1447981949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 41277) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AR 4611) |
| 122300000X Dentist (Licence: AR 4611) | |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2025-04-13 |