| NPI | 1750138202 |
|---|---|
| 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: WI 60015200-15) |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-06-01 |