| NPI | 1689939647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA ds039760) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039760) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2022-03-19 |