| NPI | 1689095911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH RES.3321) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.023931) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |