| NPI | 1598454944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 13737) |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2025-12-13 |