| NPI | 1548902240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: KY 10789) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2024-08-12 |