| NPI | 1649530601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: UT 8926334-9924) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2025-05-19 |