| NPI | 1457296311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN124149) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH RES.005048) |
| Enumeration Date | 2026-04-20 |
| Last Update Date | 2026-05-28 |