| NPI | 1477182467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA DS043222) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS043222) |
| 1223G0001X Dentist, General Practice (Licence: PA DS043222) | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2026-04-06 |