| NPI | 1649971110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 39867) |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2023-10-03 |