| NPI | 1740129147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS045780) |
| Enumeration Date | 2026-03-28 |
| Last Update Date | 2026-07-22 |