| NPI | 1578144770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 2901602762) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02901000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2025-07-14 |