| NPI | 1558981829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 7318) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7318) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2023-08-11 |