| NPI | 1518615863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 7612) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 019.033827) |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2025-04-08 |